Scientific Hepatectomy for Hepatocellular Carcinoma

作者：Jin Gu, Bin-yong Liang, Er-lei Zhang, Zun-yi Zhang, Xiao-ping Chen & Zhi-yong Huang

编辑推读

HCC作为全球主要的癌症致死原因之一，其治疗方式一直在不断探索与改进之中。尽管技术进步使得肝切除术更为精确，但患者面临的复发风险依旧较高。这是一项科学肝切除术的相关研究，为肝细胞癌（HCC）患者提供了新的治疗策略。

本研究深入探讨了HCC复发的主要原因，指出与肝硬化和肿瘤细胞的血管传播密切相关。文章提出了一种新的治疗思路，即在考虑肝切除的同时，结合肝脏移植和系统性治疗，以期达到更好的治疗效果。研究者强调了根据肝硬化的严重程度来个性化选择手术方式的重要性，并提出了将新兴的免疫相关辅助治疗整合进HCC治疗策略中的新思路。

特别值得关注的是，文章中提出的“科学肝切除”概念，这不仅仅是一种技术手段的革新，更是一种治疗理念的更新。它促使我们从更全面的角度出发，综合考虑肝脏疾病、肿瘤特性和系统性治疗等多重因素，以实现对HCC患者更为精准和有效的治疗。

随着系统性治疗的快速发展，特别是免疫治疗和分子靶向治疗的结合使用，为HCC患者提供了新的希望。这些治疗方法不仅能够提高当前不可切除HCC的切除可能性，还可能为降低术后复发率和延长患者生存期提供新的手段。

我们将这篇文章推荐给广大医疗专业人员和对HCC治疗研究感兴趣的读者。它不仅提供了关于HCC治疗的新见解，还可能引领未来治疗策略的发展方向，为HCC患者带来更光明的未来。

Gu, J., Liang, By., Zhang, El. et al. Scientific Hepatectomy for Hepatocellular Carcinoma. CURR MED SCI 43, 897–907 (2023). https://doi.org/10.1007/s11596-023-2761-2

// Abstract

With advances in imaging technology and surgical instruments, hepatectomy can be perfectly performed with technical precision for hepatocellular carcinoma (HCC). However, the 5-year tumor recurrence rates remain greater than 70%. Thus, the strategy for hepatectomy needs to be reappraised based on insights of scientific advances. Scientific evidence has suggested that the main causes of recurrence after hepatectomy for HCC are mainly related to underlying cirrhosis and the vascular spread of tumor cells that basically cannot be eradicated by hepatectomy. Liver transplantation and systemic therapy could be the solution to prevent postoperative recurrence in this regard. Therefore, determining the severity of liver cirrhosis for choosing the appropriate surgical modality, such as liver transplantation or hepatectomy, for HCC and integrating newly emerging immune-related adjuvant and/or neoadjuvant therapy into the strategy of hepatectomy for HCC have become new aspects of exploration to optimize the strategy of hepatectomy. In this new area, hepatectomy for HCC has evolved from a pure technical concept emphasizing anatomic resection into a scientific concept embracing technical considerations and scientific advances in underlying liver cirrhosis, vascular invasion, and systemic therapy. By introducing the concept of scientific hepatectomy, the indications, timing, and surgical techniques of hepatectomy will be further scientifically optimized for individual patients, and recurrence rates will be decreased and long-term survival will be further prolonged.